This study reviewed developments in provider utilization related to health care in the metropolitan area of the Syracuse hospitals between the twentieth century and the twenty first century with respect to major hospi...This study reviewed developments in provider utilization related to health care in the metropolitan area of the Syracuse hospitals between the twentieth century and the twenty first century with respect to major hospital services. In this study, a decline in the utilization of inpatient hospitals developed between 2020 and 2022. During this period, use of additional outpatient services such as ambulatory surgery, individual practitioners, outside hospitals, and the use of hospital emergency departments developed in the community. The study data demonstrated that between 2020 and 2022, the numbers of discharges from the combined hospitals declined for both adult medicine and adult surgery. Inpatient discharges declined by 2730 patients for adult medicine and 1961 patients for adult surgery. The data also demonstrated that between 2022 and 2024, the numbers of discharges increased by 1998 discharges for adult medicine and by 229 for adult surgery. As followup to this study, health care providers and payors should review approaches to efficiency in their communities and evaluate their impact on health care efficiency.展开更多
This study reviewed a combination of health care programs in the metropolitan area of Syracuse, New York. They were designed to improve care, however a major purpose was to support efficiency. The study described a nu...This study reviewed a combination of health care programs in the metropolitan area of Syracuse, New York. They were designed to improve care, however a major purpose was to support efficiency. The study described a number of individual programs that were developed in order to improve the quality and the efficiency of care. These programs were implemented by a combination of local providers and payors. They included the development of outpatient services such as ambulatory surgery, as well as preventive care, case management, telemedicine, and mental health. The impact of these programs was a combination of these services, rather than individual efforts. The impact of these efforts was the product of a range of individual services, especially care management. Additional efforts should make it possible to extend these efforts among providers and payors in the Syracuse area. This approach should make it possible to extend the impact of health care efficiency further.展开更多
Hospital admission/discharges rates are generating increased attention from health care providers and payors. This study focused on evaluation of inpatient hospital admission/discharge rates for Syracuse and other New...Hospital admission/discharges rates are generating increased attention from health care providers and payors. This study focused on evaluation of inpatient hospital admission/discharge rates for Syracuse and other New York State metropolitan areas during 2014 and 2015. It provided comparative information concerning this subject and suggested how this approach to analysis of hospital utilization could be carried out using publicly available data. The study data demonstrated that hospital admission/discharge rates per 1000 population increased with patient age in all of these areas. The study data suggested that differences in hospital admission/discharge rates among the New York State metropolitan areas were generally consistent between 2014 and 2015. Utica and New York City produced the highest rates. Rochester and Albany produced the lowest rates. Utilization rates for Syracuse were considerably lower than for Utica and New York City and slightly higher than for Rochester and Albany. This analysis demonstrated that most of the differences between aggregate rates for Syracuse and Rochester were produced by elderly patients, especially those aged 75 years and over. The analysis demonstrated that most of these differences in admission rates for the elderly were produced by adult medicine patients aged 75 years and over. Most of these differences were generated by patients with respiratory, digestive, and orthopedic disorders. Additional data suggested that the highest readmission rates for adult medicine and adult surgery were produced by patients aged 75 years and over.展开更多
Patients requiring Subacute and Complex Care services continue to challenge hospitals attempting to reduce inpatient stays and improve efficiency. In recent years, numbers of high severity of illness patients in hospi...Patients requiring Subacute and Complex Care services continue to challenge hospitals attempting to reduce inpatient stays and improve efficiency. In recent years, numbers of high severity of illness patients in hospitals have increased, adding to this challenge. Nurse care managers have a major responsibility for supporting the care of these patients. This study described the development of services for Subacute and Complex Care patients in the hospitals of Syracuse, New York. These hospitals used their own resources to develop programs including high cost medications, intravenous therapy, extensive wound care, and bariatric care in settings where they had not been available. In the absence of third party funding of another level of care, the hospitals provided program development funds for limited time periods in order to initiate these services. The Syracuse hospitals were able to phase out support for these programs after they were operational in the nursing homes for an extended period of time. The study data indicated that implementation of these programs limited the rate of increase of adult medicine stays and reduced adult surgery stays. The severity of illness for both major services increased in the Syracuse hospitals during this time. This process required acute and long term care providers who were interested in making the process work for the benefit of the patient populations involved, as well as for the needs of their own organizations.展开更多
This study evaluated the impact of high severity of illness patients on hospital utilization in the metropolitan area of Syracuse, New York between 2012 and 2015. It employed the All Patients Refined Severity of Illne...This study evaluated the impact of high severity of illness patients on hospital utilization in the metropolitan area of Syracuse, New York between 2012 and 2015. It employed the All Patients Refined Severity of Illness system developed by 3M™ Health Information Systems. These patients are important for the management and practice of nursing in acute hospitals. The study demonstrated that patients at extreme and major severity of illness generated 60 - 70 percent of the inpatient days for adult medicine and adult surgery in the combined Syracuse hospitals. Mean lengths of stay for patients at extreme severity of illness were two to four times the stays for these services. Inpatient readmission rates for extreme severity of illness patients were more than double the rates for these services. The study data also indicated that the impact of patients at high severity of illness was increasing over time. The study also demonstrated that recent efforts of the Syracuse hospitals have produced reductions in the numbers of excess patient days for adult medicine and surgery, but limited reductions in the mean lengths of stay for these patients. The data suggested that meeting the needs of these patients is especially challenging in a small metropolitan area without an additional level of care within the continuum.展开更多
This study estimated the potential impact of the nationwide shift from inpatient to outpatient care in the hospitals of Syracuse, New York, a small metropolitan area with a relatively stable population. The study empl...This study estimated the potential impact of the nationwide shift from inpatient to outpatient care in the hospitals of Syracuse, New York, a small metropolitan area with a relatively stable population. The study employed the 3M<sup>TM</sup> All Patients Refined Diagnosis Group Severity of Illness system to identify inpatients and related utilization with the greatest potential for movement from inpatient to outpatient settings. The study data suggested that the development of additional ambulatory care capacity in Syracuse could support the reduction of an average daily census of approximately 60 - 125 patients with low severity of illness, excluding readmissions. The study data also identified the potential for shifting an average daily census of approximately 9 - 19 patients who were readmitted to hospitals within 30 days of their initial admissions from inpatient to outpatient care. The study data also identified the potential for reduction of an average daily census of approximately 20 - 70 adult medicine and adult surgery patients through continued initiatives for inpatient length of stay reduction. The impact of initiatives in each of these areas could result in a reduction of the combined average daily adult medicine and adult surgery census of the Syracuse hospitals from approximately 90 to 215 patients. This would amount to between 8 and 20 percent of the current inpatient census for adult medicine and adult surgery. These data suggest that planning for initiatives such as ambulatory care development and reduction of readmissions should also include evaluation of their impact on inpatient acute care and related services.展开更多
This study evaluated length of stay reduction for adult medicine and adult surgery in the combined hospitals of Syracuse, New York between 1998 and 2016. The study was based on the All Patients Refined Severity of Ill...This study evaluated length of stay reduction for adult medicine and adult surgery in the combined hospitals of Syracuse, New York between 1998 and 2016. The study was based on the All Patients Refined Severity of Illness System. Through this approach, it controlled for changes in the degree of illness of hospital populations. The study data indicated that reductions in adult medicine and adult surgery stays in the Syracuse hospitals between 1998 and 2012 reduced the annual number of excess days compared with severity adjusted national averages by 49,000, or an average daily census of 134.2. It appeared that the shift to reimbursement by discharges initiated by Medicare was a major cause of these reductions. The impact of this change was accompanied by length of stay reduction initiatives by the Syracuse hospitals, especially relating to long-term care. Between January-April 2012 and 2016, additional reductions brought the lengths of stay for adult medicine and adult surgery in the combined Syracuse hospitals close to the national average. The study suggested that remaining opportunities for length of stay reductions in Syracuse involved patients with high severity of illness and those discharged to nursing homes.展开更多
This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospit...This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospitals and their nursing and administrative staffs, such as inpatient stays and post admission complications, as well as programs where there was less provider control such as inpatient admissions and readmissions. Large reductions in inpatient lengths of stay were generated by the Syracuse hospitals, contributing to a decline in the average daily adult medicine and adult surgery census of 140 patients. Reductions in post admission complications contributed to these developments. The study suggested that efforts to reduce inpatient admissions in the Syracuse hospitals had limited results. The areas hospital admission rate was conservative, but approximately 2000 resident discharges per year above that of a neighboring community. The need for reduction of hospital admissions resulted from the absence of provider or payor efforts to develop alternative resources in the community. If the experience of the Syracuse hospitals is typical, improvement of the efficiency of community health systems will require creativity and resources from providers. Perhaps more importantly, health care payors will need to assume an active role in these efforts.展开更多
The need for efficiency has been a major challenge for hospitals in the United States. The efficiency of these providers is directly related to their inpatient lengths of stay. The coronavirus epidemic has challenged ...The need for efficiency has been a major challenge for hospitals in the United States. The efficiency of these providers is directly related to their inpatient lengths of stay. The coronavirus epidemic has challenged the ability of hospitals in the United States to reduce stays and provide efficient care. This study described the impact of the epidemic on inpatient lengths of stay in the hospitals of Syracuse NY between March-November 2020 compared with the same periods in previous years. It demonstrated that, during this period, adult medicine lengths of stay increased by 4.5 percent and adult surgery stays increased by 5 - 6 percent. These increases were not large;however, they challenged the ability of hospitals to provide efficient care at a time when additional capacity was needed to deal with the epidemic. The results of the study suggested that the coronavirus epidemic should not limit the effectiveness of hospital programs that support efficiency and protect needed health care resources at the community level.展开更多
This study focused on hospital utilization for adult medical-surgical patients in Syracuse, New York as the census peaked then declined between December 2020 and February 2021. The initial analysis demonstrated that t...This study focused on hospital utilization for adult medical-surgical patients in Syracuse, New York as the census peaked then declined between December 2020 and February 2021. The initial analysis demonstrated that the adult medical-surgical census including Coronavirus patients declined by 8.1 percent during January and February 2021. The study data also demonstrated that the adult medical-surgical census of the combined hospitals increased as the numbers of virus patients declined. The inpatient census at the end of February 2021 was 3.6 percent below the level for February 2019 and 15.0 percent below the level for February 2020. This suggested a range between 3.6 and 15.0 percent below those in previous years for medical-surgical planning after the epidemic.展开更多
This study reviewed developments in hospitalization in the metropolitan area of Syracuse, New York during the initial months of the Coronavirus epidemic. The study was based on the use of inpatient discharge data and ...This study reviewed developments in hospitalization in the metropolitan area of Syracuse, New York during the initial months of the Coronavirus epidemic. The study was based on the use of inpatient discharge data and information contained in daily utilization reports for the three hospitals in the community distributed by the Hospital Executive Council. The data demonstrated that the medical-surgical and critical care inpatient census, as well as the emergency department volume peaked in January 2020 and declined gradually during February and the first half of March as a result of the seasonal influenza season prior to the epidemic. The data showed that with the onset of the epidemic in mid-March, the data identified substantial reductions in the use of inpatient beds and the emergency departments. The medical-surgical and critical care censuses declined by 31.2 and 29.3 percent respectively. This resulted from provider and public efforts to free inpatient beds for coronavirus patients. During April and May 2020, the use of medical-surgical beds and emergency departments in the Syracuse hospital gradually increased as the Coronavirus epidemic plateaued. Subsequent data will identify whether the use of inpatient medical - surgical beds and emergency department visits in the Syracuse hospitals return to the levels before the epidemic.展开更多
This study focused on recent issues concerning health care utilization at the community level. The study focused on developments in hospital inpatient lengths of stay and discharges. The analysis in the study demonstr...This study focused on recent issues concerning health care utilization at the community level. The study focused on developments in hospital inpatient lengths of stay and discharges. The analysis in the study demonstrated that hospital lengths of stay in the metropolitan area of Syracuse, New York increased by 25.0 percent between 2019 and 2023. This has been a notable increase in the movement of patients with this indicator. The analysis also demonstrated that numbers of inpatient discharges for these hospital services declined substantially during the same periods. Review of the data suggested that this information has been related. The increase in hospital lengths of stay has been related to a rise in numbers of patients at high severity of illness. They have also been associated with a decline in numbers of patients at low severity.展开更多
This study demonstrated that numbers of hospital inpatient discharges have declined in the metropolitan area of Syracuse, New York. The largest impact has been in adult medicine and adult surgery, the hospital service...This study demonstrated that numbers of hospital inpatient discharges have declined in the metropolitan area of Syracuse, New York. The largest impact has been in adult medicine and adult surgery, the hospital services with the highest utilization rates. Reductions in inpatient care have also affected services with lower utilization, such as pediatrics, obstetrics, and mental health. The study indicated that, between January - June 2019 and 2024, adult medicine discharges declined by 11.9 percent and adult surgery discharges declined by 24.6 percent. A large proportion of the reductions involved orthopedic surgery. They indicated that more than 50 percent of the joint replacements in the Syracuse hospitals have been moved to outpatient services. These patients included those with low severity of illness. The study suggested that reductions in hospital discharges could contribute to the efficiency of care. Fewer inpatient admissions could reduce the need for staffing and other resources. Information from the Syracuse hospitals has suggested that these reductions may continue.展开更多
This study was a brief review of issues related to health planning in the metropolitan area of Syracuse, New York. It suggested that population demographics and health care utilization can have an impact on the use of...This study was a brief review of issues related to health planning in the metropolitan area of Syracuse, New York. It suggested that population demographics and health care utilization can have an impact on the use of services at the community level. The study suggested that the utilization of services can be associated with patient demographics. In this study, younger populations were associated with lower use of hospital inpatient care. The data have also suggested that larger numbers of younger populations are not necessarily related to opportunities for expanding local health care providers. Younger populations can be associated with lower per capita use of services. The data demonstrated that there were substantial reductions in hospital discharges for adult medicine. Total discharges declined by 3999 patients between the seven months in 2019 and 2023. The data also demonstrated that there were notable reductions in hospital discharges for adult surgery.展开更多
Health care providers and payers in the United States have worked to provide care at reasonable costs. This has frequently been a challenge. For example, the COVID epidemic has generated large expenditures with limite...Health care providers and payers in the United States have worked to provide care at reasonable costs. This has frequently been a challenge. For example, the COVID epidemic has generated large expenditures with limited efforts to contain costs. Based on the experiences of providers in Syracuse, New York, this study suggested that realistic approaches are necessary to improve health care efficiency. It described three programs that have improved utilization at the community level. They have included the diversion of large numbers of ambulances that directed patients to emergency departments where care was most available. They have also involved length of stay reduction that saved thousands of patient days and made additional inpatient care available in hospitals. They have also included the use of ambulatory surgery to reduce the need for inpatient care. The data from these programs demonstrated that efforts to improve the efficiency of care can reduce inpatient utilization and improve outcomes. The Syracuse hospitals have used them to make additional capacity available for COVID patients and other populations.展开更多
Recent developments in health care have changed hospital utilization at the community level. This study provided examples of these changes in the metropolitan area of Syracuse, New York. The study demonstrated that pe...Recent developments in health care have changed hospital utilization at the community level. This study provided examples of these changes in the metropolitan area of Syracuse, New York. The study demonstrated that percent differences in discharges between the two time periods for both services changed little. For adult medicine, percent differences ranged between 16.5 and 18.0 percent while percent differences in adult surgery ranged from 23.25 to 24.93 percent. This information suggested that reductions in discharges during the five year period had stabilized. Most of these changes were associated with the movement of patients from inpatient to ambulatory care services. The largest numbers of these patients were associated with orthopedic surgery. They resulted from the movement of these patients who were at low severity of illness to ambulatory care settings. The study also identified increases in hospital lengths of stay for adult medicine and adult surgery between January-September 2019 and 2023 in the Syracuse hospitals. Adult medicine stays increased by 23.6 percent, from 4.84 to 5.98 days. Adult surgery stays increased by 25.5 percent, from 5.41 to 6.79 days.展开更多
This study reviewed recent changes in health care utilization in the health care providers of Syracuse, New York. The data indicated the largest decline in the numbers of inpatient volumes involved adult surgery and o...This study reviewed recent changes in health care utilization in the health care providers of Syracuse, New York. The data indicated the largest decline in the numbers of inpatient volumes involved adult surgery and orthopedics. Numbers of inpatient discharges for this service declined by more than 2900 discharges for the combined Syracuse hospitals. The data also indicated that adult medicine discharges declined by more than 2600 during this time. For Diagnosis Related Groups with discharge differences of 30 or more, adult medicine discharges declined by 451 in neurology, 943 in respiratory medicine, and 625 in circulatory medicine. It was estimated that the value of the inpatient discharges amounted to approximately $1,740,000 in adult surgery and more than $1,560,000 for adult medicine. The savings that were achieved in this process related to staffing, pharmaceuticals, and testing.展开更多
An important component of health care planning at the community level is the identification of inpatient hospital bed capacity. In the United States, hospitals are major providers of patient care and the largest sourc...An important component of health care planning at the community level is the identification of inpatient hospital bed capacity. In the United States, hospitals are major providers of patient care and the largest sources of health care expenses. This study evaluated inpatient hospital capacity for major services including adult medicine, adult surgery, and obstetrics. It was based on local and regional demographics, admissions per capita, inmigration, and inpatient lengths of stay. The study also involved the use of the methodology to estimate bed need based on a reduction in hospital admissions and discharges of 15 percent. This level has been the experience of area hospitals between 2019 and 2022. The study also included the use of the bed need methodology to estimate the hospital utilization based on a decline in inpatient lengths of stay. It resulted in a decline in hospital occupancy in the hospital service area from 1213.1 to 1012.6 patients based on 80 percent occupancy and the best practice hospital stays in the region.展开更多
This study described programs that support length of stay reduction in the metropolitan area of Syracuse, New York. It demonstrated that these initiatives could improve hospital efficiency by expediting the movement o...This study described programs that support length of stay reduction in the metropolitan area of Syracuse, New York. It demonstrated that these initiatives could improve hospital efficiency by expediting the movement of patients from inpatient hospitals to nursing homes at the community level. The Subacute and Complex Care Programs have focused on hospital patients with some of the longest lengths of stay. The inpatient days associated with these patients have the greatest potential for moving from acute care to long-term care providers. The use of these programs has the potential for saving staff time in hospitals associated with nurses, as well as pharmaceuticals and testing. All of these resources have contributed to the high costs of inpatient acute care.展开更多
In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and c...In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.展开更多
文摘This study reviewed developments in provider utilization related to health care in the metropolitan area of the Syracuse hospitals between the twentieth century and the twenty first century with respect to major hospital services. In this study, a decline in the utilization of inpatient hospitals developed between 2020 and 2022. During this period, use of additional outpatient services such as ambulatory surgery, individual practitioners, outside hospitals, and the use of hospital emergency departments developed in the community. The study data demonstrated that between 2020 and 2022, the numbers of discharges from the combined hospitals declined for both adult medicine and adult surgery. Inpatient discharges declined by 2730 patients for adult medicine and 1961 patients for adult surgery. The data also demonstrated that between 2022 and 2024, the numbers of discharges increased by 1998 discharges for adult medicine and by 229 for adult surgery. As followup to this study, health care providers and payors should review approaches to efficiency in their communities and evaluate their impact on health care efficiency.
文摘This study reviewed a combination of health care programs in the metropolitan area of Syracuse, New York. They were designed to improve care, however a major purpose was to support efficiency. The study described a number of individual programs that were developed in order to improve the quality and the efficiency of care. These programs were implemented by a combination of local providers and payors. They included the development of outpatient services such as ambulatory surgery, as well as preventive care, case management, telemedicine, and mental health. The impact of these programs was a combination of these services, rather than individual efforts. The impact of these efforts was the product of a range of individual services, especially care management. Additional efforts should make it possible to extend these efforts among providers and payors in the Syracuse area. This approach should make it possible to extend the impact of health care efficiency further.
文摘Hospital admission/discharges rates are generating increased attention from health care providers and payors. This study focused on evaluation of inpatient hospital admission/discharge rates for Syracuse and other New York State metropolitan areas during 2014 and 2015. It provided comparative information concerning this subject and suggested how this approach to analysis of hospital utilization could be carried out using publicly available data. The study data demonstrated that hospital admission/discharge rates per 1000 population increased with patient age in all of these areas. The study data suggested that differences in hospital admission/discharge rates among the New York State metropolitan areas were generally consistent between 2014 and 2015. Utica and New York City produced the highest rates. Rochester and Albany produced the lowest rates. Utilization rates for Syracuse were considerably lower than for Utica and New York City and slightly higher than for Rochester and Albany. This analysis demonstrated that most of the differences between aggregate rates for Syracuse and Rochester were produced by elderly patients, especially those aged 75 years and over. The analysis demonstrated that most of these differences in admission rates for the elderly were produced by adult medicine patients aged 75 years and over. Most of these differences were generated by patients with respiratory, digestive, and orthopedic disorders. Additional data suggested that the highest readmission rates for adult medicine and adult surgery were produced by patients aged 75 years and over.
文摘Patients requiring Subacute and Complex Care services continue to challenge hospitals attempting to reduce inpatient stays and improve efficiency. In recent years, numbers of high severity of illness patients in hospitals have increased, adding to this challenge. Nurse care managers have a major responsibility for supporting the care of these patients. This study described the development of services for Subacute and Complex Care patients in the hospitals of Syracuse, New York. These hospitals used their own resources to develop programs including high cost medications, intravenous therapy, extensive wound care, and bariatric care in settings where they had not been available. In the absence of third party funding of another level of care, the hospitals provided program development funds for limited time periods in order to initiate these services. The Syracuse hospitals were able to phase out support for these programs after they were operational in the nursing homes for an extended period of time. The study data indicated that implementation of these programs limited the rate of increase of adult medicine stays and reduced adult surgery stays. The severity of illness for both major services increased in the Syracuse hospitals during this time. This process required acute and long term care providers who were interested in making the process work for the benefit of the patient populations involved, as well as for the needs of their own organizations.
文摘This study evaluated the impact of high severity of illness patients on hospital utilization in the metropolitan area of Syracuse, New York between 2012 and 2015. It employed the All Patients Refined Severity of Illness system developed by 3M™ Health Information Systems. These patients are important for the management and practice of nursing in acute hospitals. The study demonstrated that patients at extreme and major severity of illness generated 60 - 70 percent of the inpatient days for adult medicine and adult surgery in the combined Syracuse hospitals. Mean lengths of stay for patients at extreme severity of illness were two to four times the stays for these services. Inpatient readmission rates for extreme severity of illness patients were more than double the rates for these services. The study data also indicated that the impact of patients at high severity of illness was increasing over time. The study also demonstrated that recent efforts of the Syracuse hospitals have produced reductions in the numbers of excess patient days for adult medicine and surgery, but limited reductions in the mean lengths of stay for these patients. The data suggested that meeting the needs of these patients is especially challenging in a small metropolitan area without an additional level of care within the continuum.
文摘This study estimated the potential impact of the nationwide shift from inpatient to outpatient care in the hospitals of Syracuse, New York, a small metropolitan area with a relatively stable population. The study employed the 3M<sup>TM</sup> All Patients Refined Diagnosis Group Severity of Illness system to identify inpatients and related utilization with the greatest potential for movement from inpatient to outpatient settings. The study data suggested that the development of additional ambulatory care capacity in Syracuse could support the reduction of an average daily census of approximately 60 - 125 patients with low severity of illness, excluding readmissions. The study data also identified the potential for shifting an average daily census of approximately 9 - 19 patients who were readmitted to hospitals within 30 days of their initial admissions from inpatient to outpatient care. The study data also identified the potential for reduction of an average daily census of approximately 20 - 70 adult medicine and adult surgery patients through continued initiatives for inpatient length of stay reduction. The impact of initiatives in each of these areas could result in a reduction of the combined average daily adult medicine and adult surgery census of the Syracuse hospitals from approximately 90 to 215 patients. This would amount to between 8 and 20 percent of the current inpatient census for adult medicine and adult surgery. These data suggest that planning for initiatives such as ambulatory care development and reduction of readmissions should also include evaluation of their impact on inpatient acute care and related services.
文摘This study evaluated length of stay reduction for adult medicine and adult surgery in the combined hospitals of Syracuse, New York between 1998 and 2016. The study was based on the All Patients Refined Severity of Illness System. Through this approach, it controlled for changes in the degree of illness of hospital populations. The study data indicated that reductions in adult medicine and adult surgery stays in the Syracuse hospitals between 1998 and 2012 reduced the annual number of excess days compared with severity adjusted national averages by 49,000, or an average daily census of 134.2. It appeared that the shift to reimbursement by discharges initiated by Medicare was a major cause of these reductions. The impact of this change was accompanied by length of stay reduction initiatives by the Syracuse hospitals, especially relating to long-term care. Between January-April 2012 and 2016, additional reductions brought the lengths of stay for adult medicine and adult surgery in the combined Syracuse hospitals close to the national average. The study suggested that remaining opportunities for length of stay reductions in Syracuse involved patients with high severity of illness and those discharged to nursing homes.
文摘This study reviewed programs to improve the efficiency of hospital utilization in the metropolitan area of Syracuse, New York between 1998 and 2015. It involved indicators that were largely under the control of hospitals and their nursing and administrative staffs, such as inpatient stays and post admission complications, as well as programs where there was less provider control such as inpatient admissions and readmissions. Large reductions in inpatient lengths of stay were generated by the Syracuse hospitals, contributing to a decline in the average daily adult medicine and adult surgery census of 140 patients. Reductions in post admission complications contributed to these developments. The study suggested that efforts to reduce inpatient admissions in the Syracuse hospitals had limited results. The areas hospital admission rate was conservative, but approximately 2000 resident discharges per year above that of a neighboring community. The need for reduction of hospital admissions resulted from the absence of provider or payor efforts to develop alternative resources in the community. If the experience of the Syracuse hospitals is typical, improvement of the efficiency of community health systems will require creativity and resources from providers. Perhaps more importantly, health care payors will need to assume an active role in these efforts.
文摘The need for efficiency has been a major challenge for hospitals in the United States. The efficiency of these providers is directly related to their inpatient lengths of stay. The coronavirus epidemic has challenged the ability of hospitals in the United States to reduce stays and provide efficient care. This study described the impact of the epidemic on inpatient lengths of stay in the hospitals of Syracuse NY between March-November 2020 compared with the same periods in previous years. It demonstrated that, during this period, adult medicine lengths of stay increased by 4.5 percent and adult surgery stays increased by 5 - 6 percent. These increases were not large;however, they challenged the ability of hospitals to provide efficient care at a time when additional capacity was needed to deal with the epidemic. The results of the study suggested that the coronavirus epidemic should not limit the effectiveness of hospital programs that support efficiency and protect needed health care resources at the community level.
文摘This study focused on hospital utilization for adult medical-surgical patients in Syracuse, New York as the census peaked then declined between December 2020 and February 2021. The initial analysis demonstrated that the adult medical-surgical census including Coronavirus patients declined by 8.1 percent during January and February 2021. The study data also demonstrated that the adult medical-surgical census of the combined hospitals increased as the numbers of virus patients declined. The inpatient census at the end of February 2021 was 3.6 percent below the level for February 2019 and 15.0 percent below the level for February 2020. This suggested a range between 3.6 and 15.0 percent below those in previous years for medical-surgical planning after the epidemic.
文摘This study reviewed developments in hospitalization in the metropolitan area of Syracuse, New York during the initial months of the Coronavirus epidemic. The study was based on the use of inpatient discharge data and information contained in daily utilization reports for the three hospitals in the community distributed by the Hospital Executive Council. The data demonstrated that the medical-surgical and critical care inpatient census, as well as the emergency department volume peaked in January 2020 and declined gradually during February and the first half of March as a result of the seasonal influenza season prior to the epidemic. The data showed that with the onset of the epidemic in mid-March, the data identified substantial reductions in the use of inpatient beds and the emergency departments. The medical-surgical and critical care censuses declined by 31.2 and 29.3 percent respectively. This resulted from provider and public efforts to free inpatient beds for coronavirus patients. During April and May 2020, the use of medical-surgical beds and emergency departments in the Syracuse hospital gradually increased as the Coronavirus epidemic plateaued. Subsequent data will identify whether the use of inpatient medical - surgical beds and emergency department visits in the Syracuse hospitals return to the levels before the epidemic.
文摘This study focused on recent issues concerning health care utilization at the community level. The study focused on developments in hospital inpatient lengths of stay and discharges. The analysis in the study demonstrated that hospital lengths of stay in the metropolitan area of Syracuse, New York increased by 25.0 percent between 2019 and 2023. This has been a notable increase in the movement of patients with this indicator. The analysis also demonstrated that numbers of inpatient discharges for these hospital services declined substantially during the same periods. Review of the data suggested that this information has been related. The increase in hospital lengths of stay has been related to a rise in numbers of patients at high severity of illness. They have also been associated with a decline in numbers of patients at low severity.
文摘This study demonstrated that numbers of hospital inpatient discharges have declined in the metropolitan area of Syracuse, New York. The largest impact has been in adult medicine and adult surgery, the hospital services with the highest utilization rates. Reductions in inpatient care have also affected services with lower utilization, such as pediatrics, obstetrics, and mental health. The study indicated that, between January - June 2019 and 2024, adult medicine discharges declined by 11.9 percent and adult surgery discharges declined by 24.6 percent. A large proportion of the reductions involved orthopedic surgery. They indicated that more than 50 percent of the joint replacements in the Syracuse hospitals have been moved to outpatient services. These patients included those with low severity of illness. The study suggested that reductions in hospital discharges could contribute to the efficiency of care. Fewer inpatient admissions could reduce the need for staffing and other resources. Information from the Syracuse hospitals has suggested that these reductions may continue.
文摘This study was a brief review of issues related to health planning in the metropolitan area of Syracuse, New York. It suggested that population demographics and health care utilization can have an impact on the use of services at the community level. The study suggested that the utilization of services can be associated with patient demographics. In this study, younger populations were associated with lower use of hospital inpatient care. The data have also suggested that larger numbers of younger populations are not necessarily related to opportunities for expanding local health care providers. Younger populations can be associated with lower per capita use of services. The data demonstrated that there were substantial reductions in hospital discharges for adult medicine. Total discharges declined by 3999 patients between the seven months in 2019 and 2023. The data also demonstrated that there were notable reductions in hospital discharges for adult surgery.
文摘Health care providers and payers in the United States have worked to provide care at reasonable costs. This has frequently been a challenge. For example, the COVID epidemic has generated large expenditures with limited efforts to contain costs. Based on the experiences of providers in Syracuse, New York, this study suggested that realistic approaches are necessary to improve health care efficiency. It described three programs that have improved utilization at the community level. They have included the diversion of large numbers of ambulances that directed patients to emergency departments where care was most available. They have also involved length of stay reduction that saved thousands of patient days and made additional inpatient care available in hospitals. They have also included the use of ambulatory surgery to reduce the need for inpatient care. The data from these programs demonstrated that efforts to improve the efficiency of care can reduce inpatient utilization and improve outcomes. The Syracuse hospitals have used them to make additional capacity available for COVID patients and other populations.
文摘Recent developments in health care have changed hospital utilization at the community level. This study provided examples of these changes in the metropolitan area of Syracuse, New York. The study demonstrated that percent differences in discharges between the two time periods for both services changed little. For adult medicine, percent differences ranged between 16.5 and 18.0 percent while percent differences in adult surgery ranged from 23.25 to 24.93 percent. This information suggested that reductions in discharges during the five year period had stabilized. Most of these changes were associated with the movement of patients from inpatient to ambulatory care services. The largest numbers of these patients were associated with orthopedic surgery. They resulted from the movement of these patients who were at low severity of illness to ambulatory care settings. The study also identified increases in hospital lengths of stay for adult medicine and adult surgery between January-September 2019 and 2023 in the Syracuse hospitals. Adult medicine stays increased by 23.6 percent, from 4.84 to 5.98 days. Adult surgery stays increased by 25.5 percent, from 5.41 to 6.79 days.
文摘This study reviewed recent changes in health care utilization in the health care providers of Syracuse, New York. The data indicated the largest decline in the numbers of inpatient volumes involved adult surgery and orthopedics. Numbers of inpatient discharges for this service declined by more than 2900 discharges for the combined Syracuse hospitals. The data also indicated that adult medicine discharges declined by more than 2600 during this time. For Diagnosis Related Groups with discharge differences of 30 or more, adult medicine discharges declined by 451 in neurology, 943 in respiratory medicine, and 625 in circulatory medicine. It was estimated that the value of the inpatient discharges amounted to approximately $1,740,000 in adult surgery and more than $1,560,000 for adult medicine. The savings that were achieved in this process related to staffing, pharmaceuticals, and testing.
文摘An important component of health care planning at the community level is the identification of inpatient hospital bed capacity. In the United States, hospitals are major providers of patient care and the largest sources of health care expenses. This study evaluated inpatient hospital capacity for major services including adult medicine, adult surgery, and obstetrics. It was based on local and regional demographics, admissions per capita, inmigration, and inpatient lengths of stay. The study also involved the use of the methodology to estimate bed need based on a reduction in hospital admissions and discharges of 15 percent. This level has been the experience of area hospitals between 2019 and 2022. The study also included the use of the bed need methodology to estimate the hospital utilization based on a decline in inpatient lengths of stay. It resulted in a decline in hospital occupancy in the hospital service area from 1213.1 to 1012.6 patients based on 80 percent occupancy and the best practice hospital stays in the region.
文摘This study described programs that support length of stay reduction in the metropolitan area of Syracuse, New York. It demonstrated that these initiatives could improve hospital efficiency by expediting the movement of patients from inpatient hospitals to nursing homes at the community level. The Subacute and Complex Care Programs have focused on hospital patients with some of the longest lengths of stay. The inpatient days associated with these patients have the greatest potential for moving from acute care to long-term care providers. The use of these programs has the potential for saving staff time in hospitals associated with nurses, as well as pharmaceuticals and testing. All of these resources have contributed to the high costs of inpatient acute care.
文摘In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.
